Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery

Paolo Del Rio,Tommaso Loderer,Federico Cozzani,Chiara Montana Montana,Giuseppe Pedrazzi,Matteo Rossini,Lorenzo Viani

doi:10.1186/s12893-019-0483-y

Paolo Del Rio, Tommaso Loderer + Show 5 more

Open Access

https://doi.org/10.1186/s12893-019-0483-y

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Journal: BMC surgery	Publication Date: Apr 1, 2019
Citations: 61	License type: open-access

Affiliation: University of Parma

Abstract

BackgroundEarly Hypocalcemia is the most frequent complication after thyroid surgery. Several studies have tried to identify factors (patient caracteristics or surgical technique variations) affecting hypocalcemia following thyroid surgery. This studiy evaluates the role of several factors in postoperative hypocalcemia development.MethodsA retrospective study conducted on 2108 patients that underwent thyroid surgery in a single center (1669 women and 439 men). Postoperative early hypocalcemia was defined as serum calcium levels lower than 8,0 mg/dl measured 24 h after surgery. Following factors were evaluated in the study: sex, age, glandular hyperfunction, preoperative diagnosis, preoperative serum calcium levels, preoperative serum PTH levels, type of surgery performed (total thyroidectomy vs. lobectomy); minimally invasive video assisted thyroidectomy (MIVAT); number of parathyroid preserved in situ, postoperative serum calcium levels, changes in perioperative calcium levels (difference between preoperative values and postoperative calcium levels), presence of carcinoma in the surgical specimen, presence of thyroiditis based on histopatology reports.ResultsAmong evaluated factors only gender and surgical procedure revealed to be significantly correlated to early hypocalcemia development. In fact female patients experienced postoperative hypocalcemia in 42% (701/1669) of cases, which was signicantly higher than the 21.4% (94/439) identified in men. We also noticed a greater hypocalcemia incidence in patient undergoing total thyroidectomy (38.8%) than in patient undergoing lobectomy group (13.8%). Early hypocalcemia development didn’t appear to be related to preoperative serum calcium levels but it showed a statistically significant correlation with perioperative serum calcium level drop.ConclusionThis findings suggest that sex (female gender is a strong risk factor),surgical procedure and perioperative changes in serum calcium are the only factors (among all variables examined) that influence early hypocalcemia development.

Highlights

Hypocalcemia is the most frequent complication after thyroid surgery
We have considered the presence of Early Hypocalcemia for calcium serum levels lower than 8.0 mg / dl measured 24 h after surgery
By analyzing the surgical procedure performed we found out that total thyroidectomy was performed in 2014 cases (95.5%) and lobectomy in 94 cases (4.5%)

Summary

Introduction

Several studies have tried to identify factors (patient caracteristics or surgical technique variations) affecting hypocalcemia following thyroid surgery. This studiy evaluates the role of several factors in postoperative hypocalcemia development. Post-thyroidectomy hypocalcemia arises because of parathyroid removal, devascularization and damage which induce a state of transient (or permanent) hypoparathyroidism. Additional mechanisms, such as vitamin D deficiency, an acute increase in calcitonin serum levels (because of gland handling during surgery) or an “hungry bone syndrome” are believed to contribute to this process [4,5,6,7,8].

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